HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: 01/01/2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

OVERVIEW

This Notice of Privacy Practices describes how SafeMind Psychiatric Wellness Center LLC (“SafeMind,” “we,” “us,” or “our”) may use and disclose your protected health information (“PHI”) and explains your rights regarding that information. PHI includes information that identifies you and relates to your past, present, or future physical or mental health condition, the care you receive, or payment for that care.

SafeMind Psychiatric Wellness Center LLC is a private outpatient psychiatric practice located at 9217 State Route 43, Suite 230, Streetsboro, Ohio 44241. We provide psychiatric evaluation, medication management, and psychotherapy services, including telepsychiatry services where appropriate.

DEFINITIONS

Individually Identifiable Health Information

“Individually Identifiable Health Information” means information, including demographic data, that is created or received by SafeMind Psychiatric Wellness Center LLC and relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care.

Such information is considered individually identifiable if it identifies the individual or if there is a reasonable basis to believe the information can be used to identify the individual. This definition is consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations at 45 C.F.R. § 160.103.

Protected Health Information (PHI)

“Protected Health Information” (“PHI”) means Individually Identifiable Health Information that is transmitted or maintained in any form or medium, including electronic, paper, or oral formats, as defined under 45 C.F.R. § 160.103.

PHI does not include:

• Education records covered by the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g;
• Records described at 20 U.S.C. § 1232g(a)(4)(B)(iv);
• Employment records maintained by SafeMind Psychiatric Wellness Center LLC in its capacity as an employer; or
• Information regarding a person who has been deceased for more than fifty (50) years, consistent with 45 C.F.R. § 164.502(f).

PHI may also be subject to additional protections under federal and state laws, including but not limited to 42 C.F.R. Part 2 governing substance use disorder treatment records, where applicable.

Our Responsibilities

SafeMind Psychiatric Wellness Center LLC is required by federal law, including HIPAA and its implementing regulations (45 C.F.R. Parts 160 and 164), to:

• Maintain the privacy and security of your Protected Health Information;
• Provide you with this Notice of Privacy Practices describing our legal duties and privacy practices;
• Notify affected individuals without unreasonable delay following the discovery of a breach of unsecured PHI, in accordance with 45 C.F.R. §§ 164.400–414;
• Abide by the terms of this Notice currently in effect.

We reserve the right to amend or revise this Notice at any time. Any revised Notice may be made effective for all Protected Health Information we maintain, including information created or received prior to the effective date of the revision.

Whenever there is a material change to our privacy practices, including changes affecting permitted uses or disclosures, your rights, our legal duties, or other privacy practices described herein, we will promptly update this Notice. The revised Notice will be made available upon request and posted on our website. Except where otherwise required by law, a material change will not be implemented prior to the effective date stated in the revised Notice.

Nothing in this Notice is intended to limit any additional protections provided under applicable federal or Ohio law.

HOW YOUR INFORMATION MAY BE USED AND DISCLOSED

SafeMind Psychiatric Wellness Center LLC may use and disclose your Protected Health Information (“PHI”) in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), its implementing regulations (45 C.F.R. Parts 160 and 164), and applicable federal and Ohio law.

We may use and disclose PHI without your written authorization for the purposes of treatment, payment, and health care operations, as permitted under 45 C.F.R. § 164.506.

Treatment

We may use and disclose your PHI for purposes of providing, coordinating, or managing your health care and related services. This includes consultation with, referral to, or communication with other health care providers involved in your care, including primary care physicians, specialists, therapists, laboratories, pharmacies, hospitals, and other providers.

Treatment disclosures may include sharing diagnostic information, medication history, laboratory results, clinical impressions, and care recommendations as reasonably necessary to facilitate continuity and quality of care.

In psychiatric practice, treatment disclosures may also include coordination related to medication management, hospitalization, emergency evaluation, or safety planning.

Payment

We may use and disclose PHI for purposes of obtaining reimbursement for services rendered. This includes submitting claims to health plans, verifying eligibility and coverage, obtaining prior authorization, responding to utilization review requests, and pursuing collection of unpaid balances.

Disclosures for payment purposes may include diagnostic codes, dates of service, types of services provided, medication information, and other data required by the payer to process claims.

If you pay for a service in full out-of-pocket and request that we not disclose information about that specific service to your health plan for payment or health care operations purposes, we will honor that request as required by 45 C.F.R. § 164.522(a)(1)(vi), unless disclosure is otherwise required by law.

Health Care Operations

We may use and disclose PHI for health care operations, which include activities necessary to operate our practice and ensure quality care. These activities include, but are not limited to, quality assessment and improvement activities, peer review, credentialing, compliance audits, licensing activities, staff training, risk management, legal consultation, accreditation, and business management.

We may also use PHI to analyze clinical outcomes, evaluate practice performance, and improve service delivery, provided such use complies with HIPAA and applicable privacy safeguards.

Business Associates

We may disclose PHI to third-party service providers, known as “Business Associates,” who perform services on our behalf, such as billing companies, electronic health record vendors, telehealth platforms, IT service providers, accountants, attorneys, and consultants. In accordance with 45 C.F.R. § 164.502(e), we require Business Associates to enter into written agreements obligating them to safeguard PHI and limit its use and disclosure to permitted purposes.

Disclosures Required or Permitted by Law

We may use or disclose PHI without your authorization when required or permitted by federal or Ohio law, including but not limited to the circumstances described below.

Public Health Activities

We may disclose PHI to public health authorities for purposes such as reporting communicable diseases, adverse medication reactions, or other matters as required by law.

Health Oversight Activities

We may disclose PHI to government agencies authorized to conduct audits, investigations, inspections, licensure activities, or oversight of the health care system.

Judicial and Administrative Proceedings

We may disclose PHI in response to a valid court order, subpoena, or other lawful legal process, subject to applicable procedural safeguards.

Law Enforcement

We may disclose PHI to law enforcement officials as required or permitted by law, including in response to lawful requests, to report certain types of injuries, or when a crime occurs on the premises.

Serious Threat to Health or Safety

Consistent with 45 C.F.R. § 164.512(j), we may disclose PHI if we believe in good faith that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or that of another person. Such disclosures may be made to law enforcement, identifiable third parties, or other appropriate persons.

Abuse, Neglect, or Domestic Violence

We may disclose PHI when required to report suspected abuse, neglect, or exploitation of a child, elder, or vulnerable adult, in accordance with applicable reporting laws.

Workers’ Compensation

We may disclose PHI as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or similar programs.

Prescription Monitoring and Controlled Substances

Where clinically appropriate or required by law, SafeMind may access and review information from state prescription monitoring programs, including the Ohio Automated Rx Reporting System (OARRS), in connection with prescribing controlled substances. Information obtained through such systems may become part of your designated record set as permitted by law.

Substance Use Disorder Records

If you receive treatment for substance use disorder, certain records may be protected under 42 C.F.R. Part 2. Such records will not be disclosed without your written consent except as specifically permitted or required by federal law.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

We will obtain your written authorization before using or disclosing your protected health information for purposes not described in this Notice, unless permitted or required by law. This includes most uses and disclosures of psychotherapy notes, marketing communications unrelated to your care, and any sale of protected health information.

Federal and state law provide additional protections for certain highly confidential information, including substance use disorder treatment records subject to 42 C.F.R. Part 2. Where applicable, such information will not be disclosed without your specific written consent except as allowed by law.

You may revoke an authorization in writing at any time, except to the extent that action has already been taken in reliance on it.

DISCLOSURES PERMITTED OR REQUIRED BY LAW

We may disclose your protected health information without your authorization in certain circumstances permitted or required by law. These may include medical emergencies, situations involving serious threat to health or safety, suspected abuse or neglect, public health reporting, health oversight activities, court orders or subpoenas, workers’ compensation claims, or law enforcement matters as legally authorized. We may also disclose limited information to prevent harm to you or others when we believe there is an imminent risk.

TELEPSYCHIATRY AND ELECTRONIC COMMUNICATION

SafeMind provides telepsychiatry services through secure, HIPAA-compliant platforms. While we take reasonable safeguards to protect your privacy, electronic communications carry inherent risks. Emails and text messages may not be fully secure. You are advised not to use electronic messaging for emergencies. In urgent situations, you should call 911 or go to the nearest emergency department.

Communications exchanged electronically may become part of your medical record at the discretion of your treating provider.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the right to inspect and obtain a copy of your health records, subject to limited exceptions. You may request that inaccurate or incomplete information be amended. You may request an accounting of certain disclosures made over the past six years, excluding disclosures for treatment, payment, and healthcare operations.

You may request restrictions on certain uses or disclosures of your information. While we are not required to agree to all requests, we will comply with restrictions required by law, including situations where you pay for services in full out-of-pocket and request that information not be shared with your health plan.

You have the right to request confidential communications by alternative means or at alternative locations. For example, you may request that we contact you only at a specific phone number or address.

You have the right to receive a paper copy of this Notice at any time.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint without fear of retaliation. You may contact:

Privacy Officer

SafeMind Psychiatric Wellness Center LLC

9217 State Route 43, Suite 230

Streetsboro, OH 44241

Phone: 216-230-3603

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

ABOUT SAFEMIND PSYCHIATRIC WELLNESS CENTER LLC

SafeMind Psychiatric Wellness Center LLC is an independently owned psychiatric practice providing outpatient psychiatric evaluation, medication management, and psychotherapy services. Administrative, billing, and technology support services are provided through contracted vendors operating under HIPAA-compliant agreements. These vendors do not provide clinical care and are contractually obligated to protect your information.